Netherlands Institute for Health Services Research NIVEL

Utrecht, Netherlands

Netherlands Institute for Health Services Research NIVEL

Utrecht, Netherlands

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de Beurs D.,Netherlands Institute for Health Services Research NIVEL
International Journal of Environmental Research and Public Health | Year: 2017

Although suicide is a major public health issue worldwide, we understand little of the onset and development of suicidal behaviour. Suicidal behaviour is argued to be the end result of the complex interaction between psychological, social and biological factors. Epidemiological studies resulted in a range of risk factors for suicidal behaviour, but we do not yet understand how their interaction increases the risk for suicidal behaviour. A new approach called network analysis can help us better understand this process as it allows us to visualize and quantify the complex association between many different symptoms or risk factors. A network analysis of data containing information on suicidal patients can help us understand how risk factors interact and how their interaction is related to suicidal thoughts and behaviour. A network perspective has been successfully applied to the field of depression and psychosis, but not yet to the field of suicidology. In this theoretical article, I will introduce the concept of network analysis to the field of suicide prevention, and offer directions for future applications and studies. © 2017 by the authors. Licensee MDPI, Basel, Switzerland.


van Dillen S.M.E.,Wageningen University | de Vries S.,Wageningen University | Groenewegen P.P.,Netherlands Institute for Health Services Research NIVEL | Groenewegen P.P.,University Utrecht | Spreeuwenberg P.,Netherlands Institute for Health Services Research NIVEL
Journal of Epidemiology and Community Health | Year: 2012

Background Previous research shows a positive link between the amount of green area in one's residential neighbourhood and self-reported health. However, little research has been done on the quality of the green area, as well as on quantity and quality of smaller natural elements in the streetscape. This study investigates the link between the objectively assessed quantity and quality of (1) green areas and (2) streetscape greenery on the one hand and three self-reported health indicators on the other. Methods 80 Dutch urban neighbourhoods were selected, varying in the amount of nearby green area per dwelling, as determined by Geographic Information System analysis. The quality of green areas, as well as the quantity and quality of streetscape greenery, was assessed by observers using an audit tool. Residents of each neighbourhood were asked to complete a questionnaire on their own health (N=1641). In multilevel regression analyses, we examined the relationship between greenspace indicators and three health indicators, controlling for socio-demographic and socioeconomic characteristics. Results Both indicators for the quantity of greenspace were positively related to all three health indicators. Quantity and quality indicators were substantially correlated in the case of streetscape greenery. Nevertheless, the quality indicators tended to have added predictive value for the health indicators, given that the quantity information was already included in the model. Conclusions The quantity and also the quality of greenspace in one's neighbourhood seem relevant with regard to health. Furthermore, streetscape greenery is at least as strongly related to self-reported health as green areas.


Albada A.,Netherlands Institute for Health Services Research NIVEL | Van Dulmen S.,Netherlands Institute for Health Services Research NIVEL | Ausems M.G.E.M.,University Utrecht | Bensing J.M.,Netherlands Institute for Health Services Research NIVEL | Bensing J.M.,University Utrecht
Genetics in Medicine | Year: 2012

Purpose: The initial breast cancer genetic counseling visit is mainly educational, with large amounts of relatively standard information and little counselee participation. Counselors might provide more counselee-specific information if counselees would participate more. A pre-visit website providing computer-tailored information and a question prompt sheet (QPS) might help counselees to pursue a more active role. Methods: Counselees were randomized to receive usual care (UC) or UC plus the pre-visit website. The QPS questions were sent to the counselor before the visit. All counselees completed a baseline questionnaire, and visits were videotaped. Results: Intervention-group counselees (n = 102) did not ask more questions than UC-group counselees (n = 90). However, counselees in the intervention group more often shared their agenda (B = 10.37; confidence interval (CI) 2.68-18.06; P = 0.01), directed the communication (B = 0.41; CI 0.28-0.53; P = 0.01), and paraphrased the counselors' words (B = 5.18; CI 0.43-9.92; P = 0.03). Counselors introduced and answered the QPS questions. As a result, they provided more information about the topics of these questions, and the information provided was more specific to whether there was an indication for DNA testing. Conclusion: A pre-visit website with QPS helped counselees to communicate more assertively. As a result, the information provided was more counselee specific, without affecting the visit duration. ©American College of Medical Genetics and Genomics.


Hansen J.,Netherlands Institute for Health Services Research NIVEL | Groenewegen P.P.,Netherlands Institute for Health Services Research NIVEL | Groenewegen P.P.,University Utrecht | Boerma W.G.W.,Netherlands Institute for Health Services Research NIVEL | Kringos D.S.,University of Amsterdam
Health Affairs | Year: 2015

In light of the growing pressure that multiple chronic diseases place on health care systems, we investigated whether strong primary care was associated with improved health outcomes for the chronically ill. We did this by combining country- and individual-level data for the twenty-seven countries of the European Union, focusing on people's selfrated health status and whether or not they had severe limitations or untreated conditions. We found that people with chronic conditions were more likely to be in good or very good health in countries that had a stronger primary care structure and better coordination of care. People with more than two chronic conditions benefited most: Their self-rated health was higher if they lived in countries with a stronger primary care structure, better continuity of care, and a more comprehensive package of primary care services. In general, while having access to a strong primary care system mattered for people with chronic conditions, the degree to which it mattered differed across specific subgroups (for example, people with primary care-sensitive conditions) and primary care dimensions. Primary care reforms, therefore, should be person centered, addressing the needs of subgroups of patients while also finding a balance between structure and service delivery. © 2015 Project HOPE- The People-to-People Health Foundation, Inc.


Bossen D.,Netherlands Institute for Health Services Research NIVEL | Veenhof C.,Netherlands Institute for Health Services Research NIVEL | Dekker J.,VU University Amsterdam | De Bakker D.,Netherlands Institute for Health Services Research NIVEL
Journal of Physical Activity and Health | Year: 2014

Background: Despite well-documented health benefits, adults with a physical chronic condition do not meet the recommended physical activity (PA) guidelines. Therefore, secondary prevention programs focusing on PA are needed. Web-based interventions have shown promise in the promotion of PA behavior change. We conducted a systematic review to summarize the evidence about the effectiveness of web-based PA interventions in adults with chronic disease. Methods: Articles were included if they evaluated a web-based PA intervention and used a randomized design. Moreover, studies were eligible for inclusion if they used a non- or minimal-treatment control group and if PA outcomes measures were applied. Seven articles were included. Results: Three highquality studies were statistically significant to the control group, whereas 2 high- and 2 low-quality studies reported nonsignificant findings. Conclusion: Our best evidence synthesis revealed that there is conflicting evidence on the effectiveness of web-based PA interventions in patients with a chronic disease. © 2014 Human Kinetics, Inc.


Bossen D.,Netherlands Institute for Health Services Research NIVEL
Journal of medical Internet research | Year: 2013

Patients with knee and/or hip osteoarthritis (OA) are less physically active than the general population, while the benefits of physical activity (PA) have been well documented. Based on the behavioral graded activity treatment, we developed a Web-based intervention to improve PA levels in patients with knee and/or hip OA, entitled "Join2move". The Join2move intervention is a self-paced 9-week PA program in which the patient's favorite recreational activity is gradually increased in a time-contingent way. The aim of the study was to investigate whether a fully automated Web-based PA intervention in patients with knee and/or hip OA would result in improved levels of PA, physical function, and self-perceived effect compared with a waiting list control group. The study design was a two-armed randomized controlled trial which was not blinded. Volunteers were recruited via articles in newspapers and health-related websites. Eligibility criteria for participants were: (1) aged 50-75 years, (2) self-reported knee and/or hip OA, (3) self-reported inactivity (30 minutes of moderate PA, 5 times or less per week), (4) no face-to-face consultation with a health care provider other than general practitioners, for OA in the last 6 months, (5) ability to access the Internet weekly, and (6) no contra-indications to exercise without supervision. Baseline, 3-month, and 12-month follow-up data were collected through online questionnaires. Primary outcomes were PA, physical function, and self-perceived effect. In a subgroup of participants, PA was measured objectively using accelerometers. Secondary outcomes were pain, fatigue, anxiety, depression, symptoms, quality of life, self-efficacy, pain coping, and locus of control. Of the 581 interested respondents, 199 eligible participants were randomly assigned to the intervention (n=100) or waiting list control group (n=99). Response rates of questionnaires were 84.4% (168/199) after 3 months and 75.4% (150/199) after 12 months. In this study, 94.0% (94/100) of participants actually started the program, and 46.0% (46/100) reached the adherence threshold of 6 out of 9 modules completed. At 3 months, participants in the intervention group reported a significantly improved physical function status (difference=6.5 points, 95% CI 1.8-11.2) and a positive self-perceived effect (OR 10.7, 95% CI 4.3-26.4) compared with the control group. No effect was found for self-reported PA. After 12 months, the intervention group showed higher levels of subjective (difference=21.2 points, 95% CI 3.6-38.9) and objective PA (difference=24 minutes, 95% CI 0.5-46.8) compared with the control group. After 12 months, no effect was found for physical function (difference=5 points, 95% CI -1.0 to 11.0) and self-perceived effect (OR 1.2, 95% CI 0.6-2.4). For several secondary endpoints, the intervention group demonstrated improvements in favor of the intervention group. Join2move resulted in changes in the desired direction for several primary and secondary outcomes. Given the benefits and its self-help format, Join2move could be a component in the effort to enhance PA in sedentary patients with knee and/or hip OA.


Noordman J.,Netherlands Institute for Health Services Research NIVEL | Verhaak P.,Netherlands Institute for Health Services Research NIVEL | Van Dulmen S.,Netherlands Institute for Health Services Research NIVEL
BMC Family Practice | Year: 2010

Background: The increasing prevalence of chronic diseases and the growing understanding that lifestyle behaviour plays an essential role in improving overall health suggest a need for increased attention to lifestyle choices in the consulting room. This study aims to examine whether or not healthy and unhealthy lifestyle choices of patients are currently being discussed more often in primary care consultations than in former decades. Furthermore, we are interested in GPs' approach to lifestyle behaviour during consultations. Lastly, we examine whether lifestyle behaviour is discussed more with certain patients during consultations, depending on gender, age and educational background. Method. We analysed video-recordings of medical consultations, collected between 1975 and 2008 in Dutch GP practices. Data were analysed using logistic regression. Results. This study shows that discussion of smoking behaviour and physical activity has increased somewhat over time. A change in discussion of nutrition and alcohol is, however, less clear. Overall, alcohol use is the least discussed and physical activity the most discussed during consultations. GPs mainly refer to lifestyle when it is relevant to the patient's complaints (symptom approach). GPs' approach to lifestyle behaviour did not change over time. In general, lifestyle behaviour is discussed more with older, male patients (except for nutrition). GPs talk about lifestyle behaviour with patients from different educational backgrounds equally (except for physical activity). Conclusion. In recent years there is greater awareness of a healthy lifestyle, which is reflected to a limited extent in this study. Still, lifestyle behaviour is discussed in only a minority of consultations. GPs do not refer to lifestyle behaviour as a routine procedure, i.e. do not include it in primary prevention. This highlights the importance of the introduction of prevention consultations, where GPs can discuss lifestyle issues with patients who do not (yet) have risk symptoms. © 2010 Noordman et al; licensee BioMed Central Ltd.


Hopman P.,Netherlands Institute for Health Services Research NIVEL | Rijken M.,Netherlands Institute for Health Services Research NIVEL
Psycho-Oncology | Year: 2015

Objective: Illness perceptions have proven to be predictive of coping and adjustment in many chronically ill patients. However, insights into illness perceptions of cancer patients are scarce. The purpose of the present study was to explore how a heterogeneous sample of cancer patients perceive their illness. We also examined the relationships between cancer patients' illness perceptions, their illness characteristics, and their coping strategies. Methods: Participants were 325 cancer patients of a generic nationwide longitudinal panel study among cancer patients in the Netherlands. They completed the revised Illness Perception Questionnaire (Winter 2011/2012) and the Mental Adjustment to Cancer Scale (Spring 2012). Analyses of variance and linear regression analyses were conducted. Results: Patients' views on the chronicity of cancer vary, but many believe their illness to be long-lasting. Furthermore, they strongly believe the cancer treatment to be effective. People with skin cancer experience relatively little negative consequences (p < 0.01). Recently treated patients experience more negative consequences (p < 0.001) and perceive their illness as more chronic (p < 0.01). Surprisingly, neither perceptions of treatment control nor perceptions of personal control are related to specific ways of coping. However, more passive ways of coping were more often found in patients who perceived their illness as long-lasting, more emotionally burdening, and having more negative consequences. Conclusions: Our findings suggest that cancer patients might benefit more from support to alleviate the perceived severity and threat of their illness rather than from (further) strengthening their control beliefs. Copyright © 2014 John Wiley & Sons, Ltd.


Hoekstra R.A.,Netherlands Institute for Health Services Research NIVEL | Heins M.J.,Netherlands Institute for Health Services Research NIVEL | Korevaar J.C.,Netherlands Institute for Health Services Research NIVEL
BMC Family Practice | Year: 2014

Background: The number of cancer survivors is increasing due to improved treatments. Consequently, general practitioners will treat more and more cancer survivors in the upcoming years. Only little is known about the care needs of these survivors and guidelines to support general practitioners in their treatment of these patients are lacking. The aim of this study was to gain insight in the health care needs of cancer survivors in general practice. Methods. A systematic review on cancer survivors' general practice needs was conducted in PubMed, Embase and the Cochrane Library of Systematic Reviews. Eligible studies could be qualitative or quantitative studies examining cancer survivors' needs in general practice. Studies of adult survivors, with any cancer type, considered free of active disease and no longer receiving active treatment, were included. For each study a quality score was given using a form developed specifically for this study. Statements about survivors' general practice needs were collected and corresponding themes were grouped. Results: Fifteen studies were included, of which twelve were qualitative. Most mentioned general practice needs were psychosocial needs, mainly being support received form the GP, followed by a need for help with medical issues, and a need for information on cancer, recovery, late treatment effects and on adjusting to life after treatment. Conclusions: Cancer survivors have different types of general practice needs that are currently not or insufficiently met. This review provides a starting point for the development of new guidelines for general practitioners to support in cancer survivorship. © 2014 Hoekstra et al.; licensee BioMed Central Ltd.


Noordman J.,Netherlands Institute for Health Services Research NIVEL | Verhaak P.,Netherlands Institute for Health Services Research NIVEL | van Dulmen S.,Netherlands Institute for Health Services Research NIVEL
Patient Education and Counseling | Year: 2011

Objective: To describe our web-enabled video-feedback method designed to reflect on the communication skills of experienced physicians. Methods: Participating physicians (n=28) received a 'personal web link' to two of their video-recorded consultations. After watching the consultations physicians received feedback by telephone or in a face-to-face meeting, structured around an individualized feedback report. This report contained scores on the communication behavior of the physician in comparison with colleagues and their own communication behavior observed in a previous study, as well as patients' opinions about their physician's communication behavior. The physicians were asked to reflect on their communication skills and to comment on the usefulness and efficiency of the feedback method. Results: Almost all physicians were satisfied with the feedback method and in particular valued the web-enabled link to the video-recorded consultations and the structured written report. Feedback by telephone or face-to-face feedback was considered equally appropriate. Conclusion: This web-enabled video-feedback method is a useful and structured design to reflect on the communication skills of physicians. Practice implications: As part of continuing medical education, feedback on communication skills should become a recurrent activity for experienced physicians. This method can also be used to reflect on the communication skills of medical students. © 2010 Elsevier Ireland Ltd.

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